Preview Mode Links will not work in preview mode


Hosted by Editor in Chief Lorenzo Norris, MD, Psychcast features mental health care professionals discussing the issues that most affect psychiatry.

Jun 24, 2020

Thomas Abt, JD, spoke with Nick Andrews about his talk at the TEDMED 2020 conference in Boston.

Mr. Abt (@Abt_Thomas), senior fellow at the Council on Criminal Justice, discussed his evidence-based and community-informed strategies for reducing urban violence. Mr. Abt earned an undergraduate degree in economics from the University of Michigan in Ann Arbor, and a law degree from Georgetown University in Washington. Mr. Abt also worked as a prosecutor in the Manhattan District Attorney’s office in New York, and as a teacher in Washington. He has no conflicts of interest.


 Mr. Abt said the three fundamental principles of focus, balance, and fairness are central to interventions for reducing urban violence.  This means focusing on people and places in which urban violence is concentrated, balancing between positive and negative incentives to reduce violence, and facilitating trust between the state and its citizens to foster a sense of fairness.

 Mr. Abt’s book, “Bleeding Out: The Devastating Consequences of Urban Violence - And a Bold New Plan for Peace in the Streets” is a compilation of 10- 12 strategies using evidence-based interventions. Mr. Abt promotes strategies informed by data and vetted by communities.

  • Success stories can be found with deterrence in Boston; and Oakland, Calif; and Cincinnati; and Indianapolis; and with cognitive-behavioral therapy (CBT) in Chicago. Those strategies have not been brought to scale or sustained over time.
  • The “Becoming a Man” program in Chicago is one the most promising examples of the power of CBT. The program focuses on at-risk youth in high school and teaches strategies for conflict resolution, interpersonal problem-solving skills, anger management, and future orientation.
  • The program has three components: vigorous youth engagement; an intensive “man’s work” educational program delving into positive masculine identity; and a CBT component.
    • CBT is only part of the success, and Mr. Abt argues that a clinical component is necessary when working with groups with traumatic backgrounds. A psychotherapy modality is required to meaningfully alter the impulsive, automatic responses that can lead to violence.
    • Street outreach workers, public health officials, and police officials have responded positively to the book. Criticism has come from political extremes.
  • Conventional narratives about urban violence suggest that it is rooted in poverty or culture, or social and economic injustice. Yet research about urban violence suggests reducing violence must focus on urban violence itself and not on ancillary topics. Structural and historical factors, such as racism and de jure and de facto segregation, have produced high rates of urban violence, but we can’t start over in a span of a few years to address those generational problems. Mr. Abt focuses on identifying interventions that target reducing violence, which has its own ripple effects on structural injustice.
  • Abt emphasizes that urban violence is a concentrated problem with larger effects. The solutions need to be direct and focused so that the effect of the interventions is not diluted and able to be applied in multiple communities. The solutions direct and focused approaches so that the effect of the interventions is not diluted and able to be applied in multiple communities.


Abt T. Bleeding Out: The Devastating Consequences of Urban Violence – And a Bold New Plan for Peace in the Streets. (Basic Books, 2019).

Obbie M. This man says his anti-violence plan would save 12,000 lives. The Atlantic.

University of Chicago. Urban Labs. Becoming a Man program.

Heller SB et al. Thinking, Fast and Slow? Some Field Experiments to Reduce Crime and Dropout in Chicago. National Bureau of Economic Research. Working Paper 21178. May 2015. Revised August 2016.

Medscape Psychcast bonus episode transcript: Click Here.

*  *  *  

Show notes by Jacqueline Posada, MD, who is associate producer of the Psychcast and consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va.  Dr. Posada has no conflicts of interest.

*  *  *  

For more MDedge Podcasts, go to

Email the show: